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Abstract

Background

Paraga, an alcoholic herbal preparation that comes in different varieties had been
shown to be commonly available to commercial drivers in southern Nigeria. This study
aims to determine the prevalence and pattern of paraga use, and to evaluate the level
of awareness of the risks entailed in taking paraga among intercity commercial drivers
operating out of motor parks in Osogbo, southwest Nigeria. We administered a locally
validated version of the WHO drug and alcohol survey questionnaire to 350 commercial
drivers.

Results

Of the 350 questionnaires administered, 332 were used for the data analysis; the remaining
18 were rejected because they had too many missing data. The prevalence rate in the
past one year was 53.6% and 43.2% for the past one month (current). Three-quarters
were moderate to heavy users, and many take the drug while working. A total of 25.6%
had been involved in road crashes after taking paraga and 36.7% had actually seen
people getting drunk from taking paraga. Only 40% of the drivers thought paraga use
was harmful to their health, the others believing it to have therapeutic values (25%)
or undecided (35.0%). Only 43.8% of the drivers would be willing to stop taking paraga.

Conclusions

Paraga use is popular among commercial drivers. Because of its alcoholic nature, drivers’
access to the concoction should be controlled and appropriate enforcement put in place.

Background

For thousands of years, the use of indigenous plants has played an important role
in the treatment of a variety of disorders in the world [1]. An estimated 80% of the developing world population utilizes traditional methods
of healing which include herbal remedies [2]. In Nigeria, more than 70% of the population depends on traditional remedies for
the initial treatment of diseases and injuries [3,4].

Traditionally, such treatments were handled by medicine men who used a varieties of
methods such as medicinal herbs, incantations, rituals, manipulations, splints and
divinations to treat their patients [5,6]. However, urbanization has changed this tradition. A new group of itinerant traditional
drug peddlers have begun peddling their wares in urban centres in Nigeria. One of
the most common herbal preparations being sold is paraga, which has been defined by
Oshodi et al. as “a mixture of unrefined or poorly refined alcohol and herbs which
is periodically ingested, as a form of self-medication against certain illnesses”
[7]. A study among secondary school students in Lagos showed that 51.5% of them have
ingested paraga in the past [7]. Its use is said to be common among drivers and there have been numerous anecdotal
and newspaper reports that as well as alcohol, paraga makers sometimes include psychoactive
herbs such as cannabis and cocaine in paraga to add some “kick” to their products
[8]. There have been concerns by safety experts about the synergetic effects that drugs
and alcohol may have on each other when combined together [9]. For example, cannabis and alcohol in combination carry a potential greater risk
than either of them alone [9,10].

Paraga use is believed to be common among drivers, but to our knowledge, no study
on its use has been conducted among them. This study is an attempt to fill the gap
in the literature. It is a three-part study. The aim of the first part was to determine
the ethanol concentration of paraga and assess paraga peddlers’ knowledge of paraga
composition, production and usage [11]. This is the second part, which is to determine the prevalence and pattern of paraga
use among intercity commercial drivers.

Methods

Data Sources: The survey was conducted in Osogbo, the capital of Osun State in southwest
Nigeria. It is a nodal town with road connections to surrounding towns and other cities
in the country. The Yoruba, one of Nigeria’s three major ethnic groups, is the predominant
ethnic group in this part of the country. The others are the Hausa/Fulani in the north
and the Igbo in the southeast. Also in Nigeria, the first and second levels of education
are the primary school education and the secondary school education, both of which
have durations of six years. Candidates with good grades at the school leaving examination
at this stage are eligible to proceed to the post-secondary level at colleges of education,
polytechnics or universities with duration ranging from three to six years. The two
major religions in Nigeria are Christianity and Islam.

The target population was the intercity commercial drivers operating from the motor
parks in Osogbo. Commercial drivers belong to the National Union of Road Transport
Workers (NURTW), which has an organization structure made up of a state chairman and
other officers. The smallest units are the motor parks, each with its unit chairman.
Osogbo has seven of these units and they were the locations of the survey. Each motor
park consists of a large open space surrounded by kiosks and shops where food stuffs,
drinks including herbal mixtures, and other items are sold.

The aim was to determine the prevalence of paraga use among intercity commercial drivers
in Osogbo. The level of awareness of paraga use was also assessed and socio-economic
correlates of paraga use were investigated

A questionnaire consisting of two parts was used to interview the drivers. The first
part consisted of questions about respondents’ personal data while the second part
was based on the WHO’s methodology for drug survey, which has been previously validated
in Nigeria [12-14]. It appraised the pattern of paraga use, factors associated with its use; and the
level of awareness of the consequences of paraga consumption by the respondents. Current
or active users were defined as those who had taken the substance at least once in
the past 30 days [12].

Ethical consideration: Ethical permission was obtained from the ethical committee of the Ladoke Akintola
University of Technology Teaching Hospital Osogbo. Permission was also obtained from
the state chairman of NURTW. A written consent was included on the first page of the
questionnaire. The drivers were encouraged to fill the forms themselves, but two trained
research assistants were recruited to administer the questionnaires to those who did
not understand written or spoken English.

Sample size calculation was based on the 67.2% prevalence rate of alcohol consumption
among commercial drivers in south-west Nigeria [14]. Subjects were recruited from all the motor parks based on proportional sampling
technique [15]. All drivers registered with each unit were eligible for inclusion. Data was analyzed
using SPSS 15.

Results

Three hundred and fifty questionnaires were distributed and collected, but 18 (5.4%)
had too many missing data and were rejected, leaving 332 (94.6%) for the final analysis.
All respondents were males. Table 1 shows other sociodemographic characteristics of the drivers.

Table 1.Sociodemographic and some other characteristics of the drivers

The mean driving experience was 14.3 (SD 7.1) years. The median distance travelled
per day was 120 Km, ranging between 10 and 715 Km. Thirty-five (10.7%) drivers averaged
one trip per day, 139 (42.6%) averaged two trips per day, 108 (33.1%) averaged three
and 44 (13.5%) averaged four trips per day. Paraga Use.

Paraga use was popular among drivers (Table 2). Most were consistent users; for example, the difference between lifetime prevalence
and prevalence in the past one year was just 3.0%. Most respondents were heavy or
moderate users, and most either use it before or during work, or with no regard to
driving activities (Table 3). One hundred and sixty-two (48.8%) respondents felt it was very/fairly easy to get
paraga, while only 30 (9.0%) thought it was difficult and 12 (3.6%) felt it was probably
impossible. Of the 184 respondents who disclosed where they obtained paraga from,
164 (89.1%) were getting it either in the motor parks or very close to the parks.
The remaining 20 (11.9%) obtained paraga either at home or in their friends’ place.

There were no significant differences in the mean age, mean driving experience and
mean distance travelled per day between drivers who were current users and those who
were not.

Drivers’ knowledge of effects of paraga

When asked about whether paraga was harmful or beneficial; 200 (60.2%) drivers responded.
Eighty (40.0%) thought that paraga was harmful to users, 50 (25.0%) believed paraga
was beneficial while the remaining 70 (35.0%) were undecided about the harmful effects
of paraga. Fifty seven of the 80 drivers who thought paraga was harmful suggested
what the harmful effects were. Most (18, 31.6%) opined that paraga can cause people
to behave badly, 13 (22.8%) believed it was harmful because it could contribute to
vehicle crashes, 12 (21.1%) and 10 (17.5%) believed that paraga could cause liver
and kidney diseases respectively. Three (5.3%) were of the opinion that they could
cause other unspecified physical illnesses while one thought taking it can lead to
family separation.

When asked to list the benefits that could be derived from paraga, 86 drivers responded
to this question. These 86 respondents included not only 48 of the original 50 respondents
who believed paraga to be beneficial, but also 36 of those who felt paraga to be harmful
and 2 of those who were not sure about the effects of paraga. Table 4 showed that after back pain, most of the imagined benefits were social (energizes
and emboldens, enhancing libido and helping to cope with frustration). When asked
to give their opinions about how dangerous it was to drive while under the influence
of paraga, 48 (14.5%) thought it was very dangerous, 32 (9.6%) thought it was quite
dangerous, 56 (16.9%) thought it was not very dangerous while 14 (4.2%) thought it
was not dangerous and 54 (16.3%) were not sure.

Table 5.Perceived harmfulness of paraga use and willingness to stop taking it among current
users

Drivers’ attitude and practice of taking paraga

One hundred and eighty four (55.4%) drivers admitted to driving after consuming paraga
in the past. Of these, 42 (22.8%) were doing it on most days, 96 (52.2%) between 1–5
times a week, 18 (9.8%) at least once a month and 28 (15.2%) rarely. One hundred and
twenty-two (36.7%) had actually seen someone behave drunkenly after consuming paraga
and 88 (26.5%) admitted to having been involved in a road crash in the past after
taking paraga. Finally, we asked current (past one month) users about their willingness
to stop taking paraga, 48 (30.0%) said they were not willing to stop, 70 respondents
(43.8%) said were willing to stop, and 42 (26.3%) did not think that taking paraga
was a problem. When willingness to stop taking paraga was compared to driver’s perceived
harmfulness of paraga, only 37.5% of those who felt paraga to be harmful would be
willing to stop it, while two-fifth would not be willing (Table 5).

Discussion

This study showed that paraga is commonly consumed by commercial vehicle drivers operating
out of the motor parks in Osogbo, southwest Nigeria. The lifetime use by 55.6% of
the drivers is higher than the 51.6% recorded among secondary school students in Lagos
[7]. This is worrisome because almost all the drivers (184 out of 188 drivers) who admitted
to taking paraga in the past also admitted to driving shortly after consuming paraga
in the past, in fact close to 75% of these respondents were doing it at least once
a week. Paraga is basically an alcoholic drink masquerading as a medicinal preparation;
it is therefore a major public health problem if a sizable proportion of commercial
drivers consistently drive under its influence [7,8].

Furthermore, paraga drinkers appear to be consistent in the usage of the drink: the
percentage difference between lifetime and current use prevalence is less than 10%.
This is similar to the findings of Oshodi et al. who also reported a less than 10%
point difference between lifetime and current use among secondary school students
in Lagos [7]. Similarly, Kadiri in a study of paraga use in a community in Lagos showed that 60%
of paraga users were taking it on daily basis [16]. Looking at the reasons given by the drivers for taking paraga offers some explanations
for this consistency in usage. For 55% of the drivers, the reason was to treat common
cold and other illnesses. Thus, the respondents might continue to take the concoction
as long as they felt they still had the illness for which paraga was being used. They
might keep on taking it, even when they know it might be harmful; equating any harmful
effects to the side effects of conventional drugs. This may explain the reason why
45% of those who felt that paraga was harmful also deemed paraga useful for treating
illnesses. In addition, the relative high cost of orthodox medicine might have encouraged
the use of alternative medicine among the populace [7]. The persistent use might also be because the drivers were getting addicted to some
of the constituents of paraga; the most likely candidate being alcohol. Reasons such
as “enjoyable taste”, “makes me to become more alert” and “makes me gain more energy”
might be the manifestations of alcohol dependence [17].

It is also instructive that almost all the suggested benefits were for treating chronic
illnesses like back pain or coping with emotional and stress related conditions. These
are conditions that are very difficult to manage, for example, chronic back pain,
which is an occupational disease of drivers, can be very difficult to treat satisfactorily
and thus, patients may be encouraged to try different types of treatment [18].

Three quarters of current users were moderate to heavy users. Also, more than 50%
of current users take paraga before driving, while driving, or at any time of the
day, meaning that a sizable proportion of the drivers were at risk of driving under
influence. This fact is buttressed by the admission by 25.6% of the drivers that they
have been involved in road crashes when they drove after taking paraga. In addition,
more than one-thirds of the drivers had seen someone become drunk on paraga.

We have shown that about 56. 3% of current users were either not willing to stop taking
paraga, or they did not see any problem attached to paraga intake. How can these persons
be persuaded to stop taking the concoction? Trying to address this question brings
another one: Is there even a need for them to stop? Should the focus be on persuading
them to avoid paraga if they want to drive?

We have established in paper one of this study, that paraga contains alcohol concentration
that is similar to alcoholic drinks [11,19]. It may therefore, be risky to drive after taking paraga, and on this evidence alone,
drivers should be advised against driving after consuming alcohol. However, paraga
also contains other ingredients such as herbs and minerals in concentrations that
can fluctuate because the production is not controlled [7,16,19]. This can be dangerous because most medicines, including herbs are potentially dangerous
when used inappropriately or in excess [20]. Furthermore, combining herbs or taking them without other herbs that are traditionally
used to ameliorate their side effects can cause serious harms [21]. Traditionally in Africa, diseases are treated with herbs prescribed by traditional
practitioners whose knowledge had been passed down through generations [6]. These medicine men had the required ethnobotanical knowledge to correctly combine
the herbs. However, urbanization and modernization has broken down this process, and
herbs are now commonly purveyed on the street. Paraga is one of the most popular forms
in which herbal medicines are now dispensed on the street, and this popularity has
come with a cost as there have been newspaper reports of deaths following consumption
of paraga [22,23]. The production and distribution of paraga needs to come under the scrutiny of the
National Agency for Food and Drug Administration and Control (NAFDAC), which has the
responsibility for controlling and regulating the manufacture, sale and packaging
of food and drug in Nigeria. There is a vital need to study the photochemistry of
the herbs used in formulating paraga, and to establish their efficacy. This will provide
a scientific basis for establishing a policy on paraga use among the populace. In
the meantime, drivers need to be educated on the potential of paraga to increase the
risk for alcohol related traffic injuries and to reduce access to the concoction by
restricting its sales in motor parks. Commercial drivers in Nigeria are members of
the National Union of Road Transport Workers (NURTW) the Road Transport Employers
Association of Nigeria (RTEAN) [24,25]. These unions have a powerful hold on their members [8], and this has been capitalized-on by the authorities to successfully promote certain
public health issues such as HIV/AIDS control and Accident Insurance among drivers
[24,25]. Such an approach can also be used to control paraga and other alcoholic drink consumption
use by commercial drivers.

Conclusions

Commercial drivers operating from motor parks in Osogbo have a high prevalence rate
for paraga use. While the risk/benefit to health is not yet fully established, the
alcoholic nature of the drinks has been proven. Therefore, drivers’ access to the
concoction should be controlled and appropriate enforcement put in place.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

OSK designed the study, executed the data management, and drafted the manuscript.
FFO provided the validated questionnaire, helped in the conceptualization and revised
the manuscript. Both authors read and approved the final manuscript.

References

WHO guidelines for assessing quality of herbal medicines with reference to contaminants
and residues. Geneva: World Health Organisation; 2007.

Oluwadiya KS: Taking alcohol by deception: an analysis of ethanol concentration of paraga, an alcoholic
herbal mixture and factors associated with its use among commercial drivers in an
urban centre in Nigeria.